Clarifying the concepts, epistemology and lexicon of person-centeredness: an essential pre-requisite for the effective operationalization of PCH within modern healthcare systems

Andrew Miles, Jonathan Elliott Asbridge

Abstract

In a previous Editorial [1], we referred to person-centered healthcare (PCH) as a new way of ‘thinking and doing’ in clinical practice, one that had become necessitated by medicine’s relentless empiricism, its positivistic reductionism and its failure to care for patients as individuals, which is to say as persons. In this, we found ourselves able to agree with Charon [2], but needing to distance ourselves from an over-arching description, by Weatherall, of modern medicine as a “failure” [3]. Indeed, modern advances in medicine may accurately be described as a triumph - but a triumph of scientific and technological advance only, not a triumph represented by an increased excellence in clinical practice per se, if excellence (versus competence) is to be defined as the successful translation of such advances to patients within an overtly humanistic framework of care - the process which represents and causes contextualisation [4]. If we add the statistics which demonstrate high rates of medical error and iatrogenic injury within health services and also the increasingly frequent institutional failings of major hospitals and the Care Home scandals of recent times to medicine’s tendency to view patients as subjects or objects or complex biological machines requiring some sort of ‘fixing’, then it is clear that modern healthcare systems are experiencing little short of an existential crisis. Such a crisis - and the high burn out rates of clinicians which also contribute to it, can no longer be ignored or ‘whitewashed’ over. Indeed, health systems themselves need to be ‘fixed’ if they are to become more ‘fit for purpose’. How, then, are such individual failings to be prevented from causing outright institutional failure? We contend that an urgent move to a more person-centered way of ‘thinking and doing’ may well represent a credible answer to such a question. But other questions must, still, legitimately, be asked: ‘What is person-centered healthcare?’ ‘How are we to understand it?’ ‘What is its essential meaning?’In a previous Editorial [1], we referred to person-centered healthcare (PCH) as a new way of ‘thinking and doing’ in clinical practice, one that had become necessitated by medicine’s relentless empiricism, its positivistic reductionism and its failure to care for patients as individuals, which is to say as persons. In this, we found ourselves able to agree with Charon [2], but needing to distance ourselves from an over-arching description, by Weatherall, of modern medicine as a “failure” [3]. Indeed, modern advances in medicine may accurately be described as a triumph - but a triumph of scientific and technological advance only, not a triumph represented by an increased excellence in clinical practice per se, if excellence (versus competence) is to be defined as the successful translation of such advances to patients within an overtly humanistic framework of care - the process which represents and causes contextualisation [4]. If we add the statistics which demonstrate high rates of medical error and iatrogenic injury within health services and also the increasingly frequent institutional failings of major hospitals and the Care Home scandals of recent times to medicine’s tendency to view patients as subjects or objects or complex biological machines requiring some sort of ‘fixing’, then it is clear that modern healthcare systems are experiencing little short of an existential crisis. Such a crisis - and the high burn out rates of clinicians which also contribute to it, can no longer be ignored or ‘whitewashed’ over. Indeed, health systems themselves need to be ‘fixed’ if they are to become more ‘fit for purpose’. How, then, are such individual failings to be prevented from causing outright institutional failure? We contend that an urgent move to a more person-centered way of ‘thinking and doing’ may well represent a credible answer to such a question. But other questions must, still, legitimately, be asked: ‘What is person-centered healthcare?’ ‘How are we to understand it?’ ‘What is its essential meaning?’

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